Imagery and emotion in chronic pain

Abstract

Psychological factors have important implications for adjustment to chronic pain, which itself has a variety of emotional consequences. Mental imagery has historically been assumed to be closely connected to emotional responses, and some experimental and clinical evidence has supported this claim. Around two in five people with chronic pain spontaneously report having mind‟s-eye mental images of their pain, although this phenomenon has received only limited research attention. This study aimed to see whether, for people with chronic pain who report these images, evoking their pain images is different from describing their pain using only single descriptive words. It was hypothesised that evoking the images would result in a stronger negative emotional response, weaker positive emotional response and an increase in the perceived pain intensity. It was also hypothesised that, compared to baseline scores, emotional and pain intensity ratings would be higher under both experimental conditions. Thirty-six participants completed an experiment interview, which employed a repeated measures design. The dependent variables were visual analogue scale ratings of pain intensity and strength of emotional experience (fear, sadness, anger, disgust and happiness). Other measures completed assessed the nature of the imagery and level of overall psychological distress. The study found that evoking pain-related mental images resulted in a temporary increase in pain intensity, sadness, anger and disgust and a decrease in happiness. However, these emotional responses were no different from those experienced when participants described their pain in single words, although this verbal task did not result in the increase in pain intensity seen when images were evoked. These results suggest that for this group of people, pain imagery is no more closely connected to emotional responses than equivalent verbal representations. However, the fact that imagery evocation resulted in a temporary increase in pain intensity where the verbal condition did not perhaps suggests that this represents a qualitatively different kind of paying attention to pain. The next steps for this small but growing field of research are considered.